We have some trends to reverse in America. Mental health disorders are the leading cause of disability in the US and Canada. Mental healthcare expenditures in the US top 57 billion annually. For too long, mental healthcare has been neglected and the bill is coming due.
Prevention is possible, and this is the time. Not simply reducing onset of mental health disorders, but reducing the symptoms of those already diagnosed.
This becomes a bit complicated, but research tells us we must reduce risk factors. Risk factors are characteristics associated with increased chance of a mental health disorder. They are individual as well as social, cultural, economic, political, and environmental. Biological pre-disposition is one example of an individual risk factor, which can be mitigated but not eliminated. Risk factors in the environment, on the other hand, often are subject to change- if not easily. Evaluation of risk factors is the groundwork for targeted prevention with impact.
There are five overall strategies supported by research:
- Strengthening families
- Strengthening individuals
- Preventing specific disorders: screening
- Promoting mental health in school
- Promoting mental health through health care and community programs ∗
There’s a theme here. Mental health prevention works when it is collaborative.
With a wide range of providers and agencies responsible for working with children, the danger is that efforts become fragmented. Staff training, which should be interdisplinary, is inconsistent. Cultural factors get brushed aside, metrics are missing. The challenge is to achieve alignment. What is needed is a common prevention agenda focused on children because half of all lifetime cases of mental and substance use disorders begin by age 14.
Effective prevention collaboratives exist. In my experience, they have one or more innovative leaders who are willing to champion the cause, one or more individuals with deep commitment to the human issue, and positive personal relationships. These groups are leading the way.
Years ago, I worked with a wonderfully outspoken director known to announce in exasperation “there is no such thing as mental health prevention!” But there could be, and it becomes possible when we’re willing to reach beyond our individual interests and territories. The public is more aware and accepting of mental health disorders than ever before. Stigma is being reduced, access to treatment increased. This is a time of opportunity.
If you’ve read this far, I want to offer the suggestion that you may be one of the new collaborative champions that we need. With enough will, smart public policies, and commitment to the collective effort, real prevention work can happen- and succeed.
∗visit The National Academy of Sciences for more detail on these strategies.